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May 2013

Do you know what your back looks like? And if you now compare your back to your hands, what appears more familiar to you? In contrast to other body areas, one’s own back cannot be seen directly, so you always have to use mirrors. The back is only perceived when it causes trouble. In most chronic back pain patients the exact localization of their pain is often difficult. This diffuseness of pain and its shifting locations are central to musculoskeletal pain syndromes, and there is evidence, especially of Lorimer’s work, that their body image has become disrupted.

Persistent pain is associated with cortical changes and altered tactile acuity. Tactile acuity is thus considered a clinical signature of primary somatosensory representation in these conditions and is increasingly being assessed in clinical practice to evaluate the extent of cortical reorganisation in chronic pain patients and to monitor change as they recover. So how good are these tests?

A lot has been written about the pitfalls of biomedical oriented beliefs in low back pain care e.g. [1] but just how far do these issues extend? Our research explored low back pain in Aboriginal Australians.

There is no shortage of clinical guidelines for CRPS. Since 2010 we have had guidelines from the Netherlands, from the UK and in the last few months from the USA. Guidelines are always an interesting beast. We decided we wanted to get an up-to-date overview on the evidence (and only the evidence) from clinical trials for any and all interventions for CRPS, be they rehabilitation based, pharmacological or surgical/ invasive.

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